Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures, 2020, Baslet et al

I think they mean, 'PNEs are more frequently diagnosed in women'.

Noting that they occur in children and that semiology here is a fancy word for diagnostic signs:

Yep, that's the level of sophistication the signs are at - if the patient brings a teddy bear into the EEG unit, you can be very sure that the epileptic seizures are psychogenic.

Clearly I'm not an expert; I don't know if PNEs exist or not. But I not exactly getting bowled over by the intellectual rigor here.

 

There's more:

This is in relation to the use of a placebo induction method (e.g. a saline injection) that the doctor says will bring on a seizure so that it can be observed:

Interictal means 'between the seizures' - so this quote is saying that cognitive and behavioural and other issues aside from the seizures aren't rare. But neither are they rare in 'real epilepsy' - after all, something is wrong with the brain

See for example this from the Epilepsy Foundation:

Obesity is identified as a risk factor for psychogenic seizures.

So, it seems quite possible that an obese young woman who doesn't respond perfectly appropriately to the doctor and who has a teddy bear with her because it helps her deal with life could get labelled with psychogenic epilepsy, even if the EEG shows epileptiform discharges (i.e. brain wave patterns suggestive of epilepsy).

Following neurosurgery! People have seizures after epilepsy surgery? Oh, they must be psychogenic seizures because the epilepsy has been fixed. There was that same assumption of medical infallibility with the presentation by a Pain Clinic psychiatrist that I was looking at recently - women with pelvic pain after surgery for endometriosis must have 'central sensitisation' that is fixed by CBT because their endometriosis has been 'fixed'.

 

To be fair, the authors seem to have done a pretty good job collating the evidence. It's just that they seem to have left their skepticism of the evidence at the door.

For example, traumatic brain injury:

So, if a patient has had moderate or severe brain injury, they deserve an unbiased examination of their seizure episodes. But if the patient has had only a mild brain injury, they do not deserve an unbiased examination of their seizure episodes? Who defines what a mild brain injury is, rather than a moderate one, for a particular person with their particular skull thickness and brain morphology?

I'm left feeling very grateful that I and no one in my family have seizures. It seems that there is a whole extra level of disbelief reserved for this symptom.